Provider Demographics
NPI:1659903292
Name:RACINE DIGESTIVE HEALTH CENTER LLC
Entity Type:Organization
Organization Name:RACINE DIGESTIVE HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KWECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-908-6507
Mailing Address - Street 1:2801 W KINNICKINNIC RIVER PKWY STE 1080
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3689
Mailing Address - Country:US
Mailing Address - Phone:414-908-6601
Mailing Address - Fax:
Practice Address - Street 1:10340 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:STURTEVANT
Practice Address - State:WI
Practice Address - Zip Code:53177-1607
Practice Address - Country:US
Practice Address - Phone:414-908-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical